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Buprenorphine an Effective Treatment for OUD With Fentanyl Use
Buprenorphine, whether administered sublingually or subcutaneously, appears to be an effective option for the treatment of opioid use disorder (OUD) with fentanyl use. Results from the post hoc analysis of a randomized 24-week clinical trial were published in JAMA Network Open.
Currently, there is limited data regarding the effectiveness of pharmacological treatment for OUD in patients also using fentanyl.
“To our knowledge, this is one of the first reports of a randomized clinical trial to examine medication treatment of OUD among patients using fentanyl that has compared subgroups with vs without fentanyl use at baseline,” wrote Edward V. Nunes, MD, Division on Substance Use Disorders, New York State Psychiatric Institute, and co-authors in the study discussion.
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Study authors sought to assess the effectiveness of sublingual buprenorphine-naloxone versus extended-release subcutaneous injection buprenorphine among patients with OUD, both with and without fentanyl use. Patients completed study visits including urine testing weekly for 12 weeks, and then 6 times between weeks 13 to 24. Main outcomes for measurement included treatment retention, percentage of urine samples returned opioid-negative, and scores on withdrawal and craving scales.
Of 428 patients, 123 showed evidence of fentanyl use at baseline while 305 did not. Of the fentanyl-positive group, 64 were randomly assigned to receive subcutaneous buprenorphine and 59 were assigned to receive sublingual buprenorphine-naloxone. In the fentanyl-negative group, 149 were treated with the extended-release injection and 156 were treated via the oral route.
Study completion rates were similar between the 2 groups (fentanyl-positive 60.5%; fentanyl-negative 56.7%). The mean percentage of urine samples negative for any opioid were 28.5% among those receiving subcutaneous buprenorphine and 18.8% among those receiving buprenorphine-naloxone in the fentanyl-positive subgroup (difference, 9.6%; 95% CI, −3.0% to 22.3%) and 36.7% among those receiving subcutaneous buprenorphine and 30.6% among those receiving buprenorphine-naloxone in the fentanyl-negative subgroup (difference, 6.1%; 95% CI, −1.9% to 14.1%), with significant main associations of baseline fentanyl status and treatment group.\
In the fentanyl-positive subgroup, the mean percentage of urine samples negative for fentanyl during the study was 74.6% among those receiving subcutaneous buprenorphine vs 61.9% among those receiving sublingual buprenorphine-naloxone (difference, 12.7%; 95% CI, 9.6%-15.9%). Withdrawal and craving both scores decreased rapidly after starting treatment across all groups.
“The findings provide tentative evidence that extended-release, subcutaneously injected formulations of buprenorphine may be advantageous for reducing opioid use among people who use fentanyl,” concluded Nunes et al. “Further research is warranted to assess the efficacy of buprenorphine and other medications for OUD among contemporary persons using fentanyl, and to further assess the relative efficacy of standard vs extended-release formulations.”
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